Present law requires hospitals that provide services to TennCare enrollees to be reimbursed from state funds based on corridor rates set by this state's actuary and approved by the bureau of TennCare ("bureau"). REIMBURSEMENT This bill adds to the present law by providing the minimum and maximum level for aggregate rates for services to TennCare enrollees to a rural hospital. A rural hospital is one in an area that is not delineated as an urbanized area by the federal census bureau and has no more than 49 licensed beds. Such aggregate rates for TennCare enrollees at rural hospitals must be based on the percentages of the rural hospital's current medicare reimbursement. For routine, nonspecialized inpatient services, the minimum level of reimbursement to the hospital is 100% and the maximum level is 120%. The director of TennCare may seek a federal waiver or other authorization deemed necessary to implement such percentages of reimbursement without requiring the expansion of medicaid. MS-DRG LIST Present law requires the bureau to publish the list of MS-DRGs included in each service category on its website, and the bureau must update the list annually to reflect all changes as necessary. Generally, MS-DRG is a classification system used by medicare to determine hospital payments based on inpatient hospital stay categories such as diagnosis, severity, and resource utilization. This bill requires the bureau to also annually furnish an updated list of MS-DRGs directly to participating rural hospitals.

Statutes affected:
Introduced: 71-5-161(d), 71-5-161